Murphy Rachel M, Dongelmans Dave A, Kom Izak Yasrebi-de, Calixto Iacer, Abu-Hanna Ameen, Jager Kitty J, de Keizer Nicolette F, Klopotowska Joanna E
Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
J Crit Care. 2023 Jun;75:154292. doi: 10.1016/j.jcrc.2023.154292. Epub 2023 Mar 21.
To investigate drug-related causes attributed to acute kidney injury (DAKI) and their documentation in patients admitted to the Intensive Care Unit (ICU).
This study was conducted in an academic hospital in the Netherlands by reusing electronic health record (EHR) data of adult ICU admissions between November 2015 to January 2020. First, ICU admissions with acute kidney injury (AKI) stage 2 or 3 were identified. Subsequently, three modes of DAKI documentation in EHR were examined: diagnosis codes (structured data), allergy module (semi-structured data), and clinical notes (unstructured data).
n total 8124 ICU admissions were included, with 542 (6.7%) ICU admissions experiencing AKI stage 2 or 3. The ICU physicians deemed 102 of these AKI cases (18.8%) to be drug-related. These DAKI cases were all documented in the clinical notes (100%), one in allergy module (1%) and none via diagnosis codes. The clinical notes required the highest time investment to analyze.
Drug-related causes comprise a substantial part of AKI in the ICU patients. However, current unstructured DAKI documentation practice via clinical notes hampers our ability to gain better insights about DAKI occurrence. Therefore, both automating DAKI identification from the clinical notes and increasing structured DAKI documentation should be encouraged.
调查重症监护病房（ICU）患者急性肾损伤（AKI）的药物相关病因及其记录情况。
本研究在荷兰一家学术医院进行，通过复用2015年11月至2020年1月期间成年ICU入院患者的电子健康记录（EHR）数据。首先，识别出急性肾损伤（AKI）2期或3期的ICU入院患者。随后，检查了EHR中药物相关急性肾损伤（DAKI）的三种记录方式：诊断代码（结构化数据）、过敏模块（半结构化数据）和临床记录（非结构化数据）。
共纳入8124例ICU入院患者，其中542例（6.7%）经历了AKI 2期或3期。ICU医生认为这些AKI病例中有102例（18.8%）与药物相关。这些DAKI病例均记录在临床记录中（100%），1例记录在过敏模块中（1%），无1例通过诊断代码记录。分析临床记录所需的时间投入最多。
药物相关病因在ICU患者的AKI中占很大一部分。然而，目前通过临床记录进行的非结构化DAKI记录方式阻碍了我们更好地了解DAKI发生情况的能力。因此，应鼓励从临床记录中自动识别DAKI并增加结构化DAKI记录。
